A Fidelity bond ($250,000 minimum), covering all of the officers and employees of the plan. Must be approved by Board of Directors. ( IC 27-13-5-2 )

Minimum net worth of $1.5 million. ( IC 27-13-12-2 )

A financial feasibility plan in accordance with IC 27-13-2-5(9).

Statements of:

Geographic area to be served, by county ( IC 27-13-2-5(11) )

The company's compliance with Point of Service Products ( IC 27-13-13-8 )

A copy of any contract that has been made or is to be made between the HMO and a Third Party Administrator, agent(s) or person(s) identified as members of the governing body and officers responsible for the conduct of the affairs of the applicant. ( IC 27-13-2-5(5) )

Evidence of coverage to enrollees with proper identifiable form numbers, to include the following items applicable to the proposed plan: ( IC 27-13-2-5(6)(7) )

The information requested in the preceding should be delivered to the following:Admissions CoordinatorIndiana Department of Insurance311 West Washington Street, Suite 300Indianapolis, Indiana 46204-2787